Authorization Form - Sandrof Auto Body

AUTHORIZATION FOR REPAIRS AND PAYMENT POLICY

Location(Required)

Consent(Required)

I, the undersigned, hereby authorize Sandrof Auto Body and its employees to begin repairs to my vehicle, and to drive my vehicle for the purpose of testing and/or inspection. I understand that an express mechanic’s lien is acknowledged on the vehicle to secure the cost of repairs thereto.

Responsibility(Required)

I understand that Sandrof Auto Body will NOT be held responsible for theft or damage of the vehicle or articles left in vehicle such as iPods, iPads, cameras, sunglasses, credit cards, money, CD’s, golf clubs, personal belongings, etc.

PLEASE REMOVE ALL PERSONAL ITEMS FROM VEHICLE BEFORE OR WHEN YOU DROP OFF FOR REPAIRS.

Storage When Not Being Repaired(Required)

I understand Sandrof Auto Body will impose a $75 per day outside storage fee and $150 per day inside storage fee after 72 hours of completion of repairs and for all vehicles not repaired by the shop.

Rental Expenses(Required)

Sandrof Auto Body will NOT be responsible for any auto rental expenses or additional insurances taken on rentals during the repair process.

Vehicle Pickup After Repair(Required)

I further understand that once my shop representative calls to inform me that the vehicle is ready, I have 24 hours to pick up the vehicle or by the following business day.

Authorize Insurance Company(Required)

I authorize the Insurance Company to pay Sandrof Auto Body direct for all supplemental and original repairs. I authorize Sandrof Auto Body to endorse my name to any insurance check received for payment for repairs of my vehicle.

Deductible Payment(Required)

I understand that my deductible payment as well as any payments I have received from my insurance company based on the estimate for my damages is due upon drop off of my vehicle for scheduled repairs.

Payment Policy(Required)

I understand the listed payment policy as follows: Insurance Checks (best method), Cash, or Debit Card/ Credit Cards (Visa, MasterCard, Discover, and AMEX). I am responsible for payment in full for the repairs of my vehicle either before or after completion of work. I further understand that Sandrof Auto Body is unable to release any vehicle without full payment.

Legal Fees(Required)

In the event Sandrof Auto Body, its assigns, or agent must institute civil or criminal proceedings to collect on an outstanding balance, I will be liable for the reasonable costs incurred, including attorney’s fees and costs of litigation.

Insurance Deems Total Loss(Required)

In the event that the insurance deems my vehicle a total loss, I understand that Sandrof Auto Body will no longer perform any repairs to my vehicle regardless of whether I owner retain the vehicle. Reassembly of the disassembled parts will only be completed if I or the insurance company approves paying for the reassembly. A complete reassembly may not be possible due to the damages.

Restock Fee(Required)

I agree that a 25% restock fee will be assessed if cancellation of scheduled repairs is made after parts have been ordered. I will be charged the full cost of any parts that cannot be returned.

Full Tank of Gas(Required)

All customers are advised to leave the vehicle with a full tank of gas to allow the shop to complete test drives, calibrations that require a full tank of gas per manufacturer guidelines, and transportations needed to sublet vendors for mechanical services such as alignments, tires, or computer diagnostics. Sandrof Auto Body charges $9.95 per gallon for gas that must be supplied in vehicles for the purpose of repairs.

Full Name(Required)

Email(Required)

Cell Phone(Required)

Home Phone

Communication Preference(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Insurance Company(Required)

Insurance Company

Claim Number

Vehicle Make(Required)

Model(Required)

Year(Required)

VIN #

Terms and Conditions(Required)

I have read and agree to the terms and conditions stated above and authorize Sandrof Auto Body to repair my vehicle.(Required)

Date(Required)

Month

Day

Year

Signature(Required)

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